How will my treatment be determined?

Your treatment will depend on the staging of your cancer and risk assessment.

Staging

Staging of the cancer is used to describe its size and position and whether it has spread from where it started. To gather this information, your doctor may wish to carry out an MRI scan, a positron emission tomography (PET) scan, a computed tomography (CT) scan, pelvic node dissection and/or a bone scan (Parker et al., 2015).

MRI scan: MRI uses magnetic fields and radio waves to produce detailed images of the inside of your body. PET scan: PET uses a radioactive substance injected into a vein and can help find areas of cancer that an MRI or CT scan may miss. Most PET scans are now performed along with a CT scan. CT scan: This is a type of x-ray technique that lets doctors see your internal organs in cross-section. Pelvic node dissection: This is a procedure to remove pelvic lymph nodes to check if they contain cancerous cells. Bone scan: This is a scan to look for bone metastases and involves a small amount of radioactive substance injected into a vein to allow doctors to see abnormal areas of bone across your whole body, as abnormal bone absorbs more radioactivity than healthy bone.

After diagnosis, imaging scans can show how far advanced the prostate cancer is

Staging to determine the size and spread of the cancer is described using a sequence of letters and numbers. For prostate cancer, there are four stages designated with Roman numerals I to IV. Generally, the lower the stage, the better the outcome (or prognosis) for the patient. The TNM staging system considers: • How big the cancer is, or tumour size (T). • Whether the cancer has spread to lymph nodes (N). • Whether it has spread to distant sites, or metastases (M).

Staging helps to determine the most appropriate treatment for prostate cancer

The stage grouping system for prostate cancer is described in the table below (Parker et al., 2015). This may seem complicated but your doctor will be able to explain which parts of this table correspond to your cancer.

Stage I. Cancer is confined to half of one side of the prostate, or less (T1-N0-M0 or T2a-N0-M0)

Stage II. Cancer is in more than half of one side of the prostate, but is still contained within the prostate gland (T2b-N0-M0 or T2c-N0-M0)

Stage III. Cancer has broken through the covering of the prostate gland and may have spread into the seminal vesicles (T3-N0-M0)

Stage IV. Cancer has spread into nearby body organs, such as the rectum or bladder (T4-N0-M0), to nearby lymph nodes (any T-N1-M0), or to other parts of the body outside the pelvis (any T-any N-M1)

T

N

T M

N

M

• Clinically inapparent tumour neither palpable nor visible by imaging (T1) • Tumour involves one half of one lobe or less (T2a) • No regional lymph node metastasis (N0)

• No distant metastasis (M0)

• Tumour involves more than one half of one lobe but not both lobes (T2b) • Tumour involves both lobes (T2c) • No regional lymph node metastasis (N0)

• No distant metastasis (M0)

T

N

M

• Tumour extends through the prostate capsule (T3) • No regional lymph node metastasis (N0)

• No distant metastasis (M0)

T

N

M

• Tumour is fixed or invades adjacent structures other than seminal vesicles, such as external sphincter, rectum, bladder, levator muscles, and/or pelvic wall (T4) • Metastasis in regional lymph node(s) (N1)

• Distant metastasis (M1)

Stage grouping system for prostate cancer.